Fallopian Tube and Ovarian Malignancy

Schwartz's Principles of Surgery

 Chapter 41. Gynecology 

Epithelial Fallopian Tube and Ovarian Malignancy Presentation and Screening of Tubal and

Epithelial Ovarian Neoplasms:22,400 new cases and 15,280 deaths fractional death rate of 68%most deadly of gynecologic cancersCommon symptoms for either benign or

malignant ovarian tumors include :pelvic discomfort, cramping, pain, fullness,

headache, backache, and others

ovarian cancer symptom index:describes symptoms of bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms of urgency or frequency CA 125 is used commonly but has only been

approved by the U.S. Food and Drug Administration for use as a biomarker to follow response to therapy for ovarian and tubal cancer patients.

Risk Factors Approximately 90% of ovarian cancer is

sporadic; of the remaining 10% of cases, 75% of hereditary ovarian cancers has been attributed to mutations in the BRCA1 and BRCA2 genes, 7% to hereditary nonpolyposis colorectal cancer syndrome, and the remainder to familial cancer of undefined genetic origin.

Controversy exists as to the protective effect of oral contraception pills.

The only confirmed prevention is risk-reducing salpingo-oophorectomy (RRSO).

A RRSO procedure must include, at a minimum, the complete resection of the ovaries and extrauterine fallopian tubes bilaterally.

Types of Epithelial Tubal and Ovarian Neoplasms Benign Neoplasms:Cystic masses are the most common benign

findings and include: follicular cysts, endometriomas, and cystadenomas or cystadenofibromas.

Tubal Intraepithelial Neoplasia The ovary contains limited epithelium, the

single-cell thick-surface epithelial layer and the epithelium lining inclusion cysts.

The fallopian tube contains the largest surface area of epithelium in the gynecologic organs. This epithelium is organized in a serous papillary pattern, one that is seen in well-differentiated ovarian and tubal neoplasms .

Low Malignant Potential Tumor histology includes all subtypes identified for

frank malignancy: papillary serous, mucinous, clear-cell, endometrioid, and transitional or Brenner tumor.

Surgical intervention is the recommendation of choice. Stages I and II LMP tumors have a 10-year survival of nearly 100%.

Invasive Tubal and Epithelial Ovarian Cancers Initial staging and cytoreduction Interval debulking Second look procedures Secondary cytoreduction Palliation of disease complications

Primary Debulking Surgery Standard primary debulking of epithelial

ovarian cancer includes removal of the uterus, tubes, ovaries, and omentum.

Dissection of pelvic and periaortic lymph nodes is required if no gross intraperitoneal disease (>2 cm in longest diameter) is seen.

Nonepithelial Cancers of the Ovary and Fallopian Tube Germ Cell Tumorsoccur most commonly in women under age 30

years old, grow and disseminate rapidly, and are symptomatic.

Most common are the benign forms of teratomas; within the malignant category, the most common malignant form is dysgerminoma.

Sex Cord-Stromal Cell Tumors

combinations of the mesenchymal (fibromas, sarcomas) and sex cord cell components (granulosa, theca, Sertoli, Leydig.